Intraneoplastic local injection of adriamycin for malignant brain tumor chemotherapy--a clinicopathological study
Shimura, T.; Nakazawa, S.
No Shinkei Geka. Neurological Surgery 8(1): 35-42
1980
ISSN/ISBN: 0301-2603 PMID: 6244509 Document Number: 159482
The morphology of 4 autopsy and 6 biopsy cases of severe necrosis of malignant brain tumors undoubtedly attributable to the intraneoplastic injection of adriamycin is described. The concentration of adriamycin in the tumor tissue was estimated by fluorescence assay at various times after local injection of the drug. After partial removal of the malignant brain tumor, Ommaya's device was placed on the tumor bed and its reservoir was fixed subcutaneously on the skull. Adriamycin (0.5 mg/ml) was injected by percutaneous puncture into the Ommaya's reservoir every other day. Usual total doses of adriamycin was 5 mg. In addition, the patients were treated with Co60 irradiation and immunotherapy after the local injection of adriamycin. In the macroscopical findings, an extensive necrotic tissue and a small hemorrhage were observed around the tumor bed whose depth was 2-3 cm from the surface. In the microscopical findings of the tumor bed, there were massive coagulation necrosis of the tumor tissue and various vascular changes, such as fibrinoid degeneration, fibrin thrombi and occlusion of arterioles and capillaries and fibrinoid necrosis. In the surrounding areas of the massive coagulation necrosis, there were many reactive collagenous tissues and increasing fibrillary neuroglia of the brain without residual tumor cells. Locally injected adriamycin apparently has complete destructive effects to the malignant tumor cells. In the autopsy cases, the distant tumor tissues which did not touch with the adriamycin still increased and spread into other parts of the brain. The tissue concentration of adriamycin which was estimated by fluorescence assay was very high (77.06-3.27 mcg/g) 3 h after intraneoplastic injection; it remained at a very high level of about 1.13 mcg/g in the tissues 16 h after injection. The level of adriamycin remains for a very long time in the tumor tissue and kills malignant tumor cells completely, when the drug is administered into the tumor bed by local injection. The intraneoplastic injection method of chemotherapy seems to be very effective for the treatment of a malignant brain tumor.